Gossips, Stigma and HIV

Though I completed the last two and a half years of my high school education in the states, I actually had four years of my secondary (from 7th to 12th grades) school education in Nigeria. I have come to realize that to truly understand the fears and worries of a nation, you should look at what that nation teaches its youth. In my school in Nigeria (a federal government college), while there were the humdrum talks against vandalism, for the most part a corporal punishment system and cultural differences meant that unlike my American high school, things like vandalism and respect were not real issues. However, what was taught to everyone beginning in the 8th grade, and continuing onwards in an almost cloying concentration, was learning about HIV/AIDS and other ‘fun’ STDs around. It is in fact no secret that Africa is facing an AIDS epidemic, and the amount of effort put in the educational system towards prevention is evidence of it. While after the first 3 lectures, it got a bit boring and the same, the message was quite clear and everyone understood the risks. No one wanted (and I believe no one wants) to get HIV or AIDS.

However, the emphasis on prevention and reduction of cultural stigma left little room for talk of how those with the disease actually survived. Of course we all learned about anti-retrovirals, but they were described as drugs that only the rich people received and so made HIV seem like a death sentence. We learned that you did not get HIV from touching or shaking hands or from sharing a cup of water, but for the most part we got taught prevention. So it was with surprise that I learned of the problems with cultural stigma causing increased spread of HIV. Now thinking back, while the prevention topics did their job to terrify me, they also worked to make me afraid of those with HIV and hence distorted from the success of the work against social stigma. It is the stigma that I believe causes an increased risk of spread of disease. No one wants to admit they have HIV.

In an article quoting Dr. Abiola Davies an HIV specialist in Nigeria, she claims that “HIV transmission through the mother-to-child route was a “relatively invisible” epidemic at local levels and was hampering action”. Her solution was to begin programs providing “good HIV intervention processes through antenatal care” and she believed that such a program would “guarantee the survival of every other HIV positive infant who would not have lived to see its 2nd birthday if there had been no intervention”.

While I agree that her solution would work, it would also require the either enforced HIV testing of new members, or the reduction of social stigma around HIV that prevents people from self-identifying as carriers. As a Nigerian myself, would I trust the health workers at the hospital to not gossip? Absolutely not! In fact I expect them to. The stigma and trust issues are problems that should be tackled by the Ministry of Health as a whole, but should also play a part in programming initiatives developed, otherwise they face disuse.

How do we fix the stigma issue? Start at schools. Rework the educational materials to be more educational and less terrifying. As for the trust issue? Watch any Nigerian movie and the first problem is most likely caused by gossiping adults. It is a cultural fact, and something that has to be made punishable, for it to begin to have an effect on healthcare workers. My mother is a nurse, and while I do not remember her gossiping about patients or naming names, the cultural assumption I have is that someone else could do it, and I would not feel comfortable sharing such personal and potentially damaging information with others.

While I never thought I would use those long and laborious lectures on the evils of STDs for no more than to remember to try not to get an STD, thinking about information and social constructions around issues are necessary to make viable plans. While I do not think Dr. Davies will read this article (though I hope she does and expands more on how she plans to identify HIV positive infants), I hope that someone else does and uses it to think holistically about a problem before implementing solutions.

References:

http://allafrica.com/stories/201107050687.html